Re: health visiting practice

March 16, 2008

ï»¿

Can I add school nursing to this debate too please? We are chronically understaffed and I am sure Cameron will appreciate this once his children begin school!

Barbara

health visiting practice

Dear all

In view of the discussions, first about the possible increase in health visiting numbers, if the Tories are elected and do what they say they will, or if the present government pick up on it and increase staffing themselves, and second following the discussion sparked by 's revelations, I would be interested in views about how we should describe a 'proper' (ie, positive) health visiting service.ï¿½ï¿½

As health visitors,ï¿½ I think we all recognise the potential harm from very fragmented service provision, but the challenge is to be able to describe this for commissioners and managers who are not health visitors.ï¿½ ï¿½I attach, and paste below for those who do not receive attachments, an excerpt from a paper Iï¿½ prepared at short notice for the Tory think tank (Centre for Social Justice) looking at early years provision.ï¿½ I would hasten to say that lots of others (including CPHVA) were contacted by them, so it was not only me briefing them about the need for more health visitors!ï¿½ï¿½

However, we have a bit of space now to toss the ideas around and I wonder what I have missed out or if there are any points with which people disagree?ï¿½ Part of what was in my mind, was to refute the idea that any member of the children's service can deliver health visiting, and that the tasks/activities count more than the skills/abilities of the professionals concerned.ï¿½ I hope it might be helpful to and her CPTs, in arguing against the constraints being placed upon them.

best wishes

Health visiting services:ï¿½ commissioning guidance includes[ii]ï¿½

ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting services should be developed according to an assessment of need at two different levels:

oï¿½ï¿½ï¿½ï¿½ï¿½ The level of overall service provision is decided according to assessments at an area level

oï¿½ï¿½ï¿½ï¿½ï¿½ The level of service offered to a particular family is personalized according to individual assessments

ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting services need to encompass prevention at three levels:ï¿½

oï¿½ï¿½ï¿½ï¿½ï¿½ Universal prevention provided to all (incorporating the child health promotion programme)

oï¿½ï¿½ï¿½ï¿½ï¿½ Indicated prevention (extra health visiting offered depending on individual assessments of need, e.g. for mental health concerns or children with special and complex needs, or for safeguarding)

oï¿½ï¿½ï¿½ï¿½ï¿½ Selective prevention (e.g., to vulnerable groups like travelers, asylum seekers, looked after children; or intensive home visiting programmes to selected groups of parents)

ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting services need to be based on best evidence and policy, by

oï¿½ï¿½ï¿½ï¿½ï¿½ encompassing evidence based programmes (e.g., for selective provision, or for the child health promotion programme),

oï¿½ï¿½ï¿½ï¿½ï¿½ providing individualized advice and support based on evidence based interventions, and according to assessed need

ï¿½

ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ The evidence suggests that, in the early years, professionally led, multi-component services are most likely to be effective in supporting family wellness and prevention of child maltreatment[iii].ï¿½

oï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting is distinctive in providing a generic service that includes the key features listed above, which meets criteria for effectiveness.

oï¿½ï¿½ï¿½ï¿½ï¿½ It should be well placed to achieve its potential in terms of enhanced support for infants, pre-school children and their families, although service reductions have an inhibiting effect.ï¿½

oï¿½ï¿½ï¿½ï¿½ï¿½ Services that are both relationship-centred and strengths-based are experienced more positively by families than ones focused on risks and problems, or upon separate tasks to be delivered, which has implications for skillmix.ï¿½

ï¿½

The key features required for an effective health visiting service are now relatively well known and have been widely articulated within the health visiting literature and elsewhere[iv] [v] [vi] [vii] [viii] [ix][x] [xi] [xii] [xiii] [xiv] [xv] [xvi].ï¿½

Health and well-being are viewed as positive concepts and a resource for everyday life; not merely the absence of disease or control of lifestyle choices and risks.ï¿½ï¿½

Health visitors understand the bio-medical model of health and its importance in disease aetiology (pathogenesis), but they are primarily interested in what creates health (salutogenesis).ï¿½

Concepts of health rooted in social, environmental and community concerns predominate.ï¿½

The socio-cultural context is central to the aetiology of health inequalities, which are a major, current public health concern and a key area of interest for health visitors.

Physical, mental and social well-being are all central to the meaning of ï¿½health.ï¿½ï¿½

Health visiting practice often begins from a single, narrow point, then expands to a wider outlook.ï¿½ This operates at three levels:

At an individual/family level, a surface reason for contact (e.g. discuss infant feeding) enables the opportunity for submerged and hidden needs to be identified

Collaboration, co-ordination and networking shifts from a single individual or family to the wider community and back again, or from a single caseload across statutory and voluntary agencies.

As health visitors work across these interfaces and with the biological, psychological, social and economic aspects of peopleï¿½s lives, they are able to gather and analyse information on different aspects of a communityï¿½s health and well-being.

A long term outlook and understanding of the socio-cultural context, and how this can influence and the choices and activities adopted by individuals, families and communities, is required.ï¿½

Health visitors hold a caseload of families located in a particular area (either drawn from GP list or geographical locality), which enables continuity and the establishment of networks and relationships.

Health visitors act as an interface between groups and individuals in the population, and population-based approaches.ï¿½

The health visiting contribution to public health takes account of the different dynamics and needs of individuals, families and groups, and the community as a whole, often working at a ï¿½pre-needï¿½ stage.ï¿½

This proactive approach operates through the universal service, which is discussed further below.

The universal service for infants and their families allows entry to whole communities and local areas.

This includes outreach to family members from other age groups and vulnerable populations who may otherwise be excluded or who find services hard to access.

Providing a service to everyone promotes acceptability, because no-one needs to feel stigmatised or particularly ï¿½picked onï¿½ by an offer of health visiting services.

Despite being universally available to all families with young children, the service is not delivered in a uniform way.ï¿½ Instead, it is personally tailored to each family and individual.

Health visiting practice operates through relationships based on partnership and an empowerment (strengths-based) approach.

The facilitators of this kind of working are well established, and include issues such as the practitioner having sufficient time to listen to clients, to develop a trusting relationship and having the knowledge and resources to respond to needs once they are identified; organisational resources such as clinical supervision are important

Barriers include the lack of communication skill, lack of time and knowledge, leading to an inability to adopt a suitably open and non-judgemental stance, and authoritarian management approaches, including pre-set requirements/criteria for assessment and service delivery.

ï¿½

Cowley S.ï¿½ A funding model for health visiting: baseline requirements ï¿½ part 1.ï¿½ Community Practitioner 2007; 80(11): 18-24

[ii] Cowley S.ï¿½ A funding model for health visiting (part 2): impact and implementation.ï¿½ Community Practitioner 2007; 80(12): 24-31

[iii] Macleod J & G. Programs for the promotion of family wellness and the prevention of child maltreatment: a meta-analytic review.ï¿½ Child Abuse & Neglect, 2000.ï¿½ 24, 9, 1127ï¿½1149

[iv] Council for the Education and Training of Health Visitors (CETHV) An Investigation into the Principles of Health Visitingï¿½ï¿½ CETHV London; 1977

[v] Twinn S & Cowley Sï¿½ eds.ï¿½ The principles of health visiting:ï¿½ a re-examination ï¿½ï¿½Health Visitors' Association and UK Standing Conference on Health Visiting Educationï¿½ Londonï¿½ 1992

[vi] Cowley S & Frost M. ï¿½The Principles of Health Visiting:ï¿½ Opening the door to public health.ï¿½ CPHVA & UKSC, London.ï¿½ 2006

[vii] Jï¿½ Health visiting and healthï¿½ Political Issues in Nursing:ï¿½ Past, present and futureï¿½ Wiley & Sons Ltdï¿½ (ed R White)ï¿½ 1985.ï¿½ 67-86

J, Effective healthcare and policy action: the example of health visiting (editorial) in Journal of Advanced Nursing, 32(6), 1315-1318, 2000

[viii] Prime Research and Development. Developing standards and competences for Health Visiting.ï¿½ A report of the development process and thinking UKCC, London, 2001

[ix] F, Cowley S & Buttigieg M (1995)ï¿½ Weights and Measures:ï¿½ Outcomes and evaluation in health visitingï¿½ Health Visitors' Associationï¿½ London

[x] World Health Organisation (WHO) Ottawa Charter for Health Promotionï¿½ WHO Canada 1986

[xi] World Health Organisation, Health Promotion Glossary WHO, Geneva, 1998

[xii] Rijke R.ï¿½ Health in medical science: from determinism towards autonomy.ï¿½ Inï¿½ Lafaille R. & Fulder S edsï¿½ Towards a New Science of Health ï¿½Routledge, London 74-83ï¿½ 1993

[xiii] Seedhouse Dï¿½ Health:ï¿½ The Foundations for Achievementï¿½ Wiley and Sons, Chichester, 1986

[xiv] Antonovsky A.ï¿½ Unraveling the Mystery of Health:ï¿½ How people manage stress and stay wellï¿½ Jossey Bass, San Francisco.ï¿½ 1987

[xv] , H., Day, C., and Bidmead, C. Working in Partnership with Parents: The Parent Adviser Model. London, The Psychological Corporation. 2002

[xvi]Bidmead C & Cowley S (in press) Partnership working to engage the client and health visitor The carrot or the stick? Towards effective practice with involuntary clients.ï¿½ (Editor:ï¿½ C Calder) (forthcoming 2008)

sarahcowley183@...

http://myprofile.cos.com/S124021COn

Dear allIn view of the discussions, first about the possible increase in health visiting numbers, if the Tories are elected and do what they say they will, or if the present government pick up on it and increase staffing themselves, and second following the discussion sparked by 's revelations, I would be interested in views about how we should describe a 'proper' (ie, positive) health visiting service.As health visitors, I think we all recognise the potential harm from very fragmented service provision, but the challenge is to be able to describe this for commissioners and managers who are not health visitors. I attach, and paste below for those who do not receive attachments, an excerpt from a paper I prepared at short notice for the Tory think tank (Centre for Social Justice) looking at early years provision. I would hasten to say that lots of others (including CPHVA) were contacted by them, so it was not only me briefing them about the need for more health visitors!However, we have a bit of space now to toss the ideas around and I wonder what I have missed out or if there are any points with which people disagree? Part of what was in my mind, was to refute the idea that any member of the children's service can deliver health visiting, and that the tasks/activities count more than the skills/ abilities of the professionals concerned. I hope it might be helpful to and her CPTs, in arguing against the constraints being placed upon them.best wishesï¿¼Health visiting services: commissioning guidance includes[ii]Â· Health visiting services should be developed according to an assessment of need at two different levels:o The level of overall service provision is decided according to assessments at an area levelo The level of service offered to a particular family is personalized according to individual assessmentsÂ· Health visiting services need to encompass prevention at three levels:o Universal prevention provided to all (incorporating the child health promotion programme)o Indicated prevention (extra health visiting offered depending on individual assessments of need, e.g. for mental health concerns or children with special and complex needs, or for safeguarding)o Selective prevention (e.g., to vulnerable groups like travelers, asylum seekers, looked after children; or intensive home visiting programmes to selected groups of parents)Â· Health visiting services need to be based on best evidence and policy, byo encompassing evidence based programmes (e.g., for selective provision, or for the child health promotion programme),o providing individualized advice and support based on evidence based interventions, and according to assessed needÂ· The evidence suggests that, in the early years, professionally led, multi-component services are most likely to be effective in supporting family wellness and prevention of child maltreatment[iii].o Health visiting is distinctive in providing a generic service that includes the key features listed above, which meets criteria for effectiveness.o It should be well placed to achieve its potential in terms of enhanced support for infants, pre-school children and their families, although service reductions have an inhibiting effect.o Services that are both relationship-centred and strengths- based are experienced more positively by families than ones focused on risks and problems, or upon separate tasks to be delivered, which has implications for skillmix.The key features required for an effective health visiting service are now relatively well known and have been widely articulated within the health visiting literature and elsewhere[iv] [v] [vi] [vii] [viii] [ix][x] [xi] [xii] [xiii] [xiv] [xv] [xvi].Health and well-being are viewed as positive concepts and a resource for everyday life; not merely the absence of disease or control of lifestyle choices and risks.Health visitors understand the bio-medical model of health and its importance in disease aetiology (pathogenesis), but they are primarily interested in what creates health (salutogenesis).Concepts of health rooted in social, environmental and community concerns predominate.The socio-cultural context is central to the aetiology of health inequalities, which are a major, current public health concern and a key area of interest for health visitors.Physical, mental and social well-being are all central to the meaning of â€˜health.â€™Health visiting practice often begins from a single, narrow point, then expands to a wider outlook. This operates at three levels:At an individual/family level, a surface reason for contact (e.g. discuss infant feeding) enables the opportunity for submerged and hidden needs to be identifiedCollaboration, co-ordination and networking shifts from a single individual or family to the wider community and back again, or from a single caseload across statutory and voluntary agencies.As health visitors work across these interfaces and with the biological, psychological, social and economic aspects of peopleâ€™s lives, they are able to gather and analyse information on different aspects of a communityâ€™s health and well-being.A long term outlook and understanding of the socio-cultural context, and how this can influence and the choices and activities adopted by individuals, families and communities, is required.Health visitors hold a caseload of families located in a particular area (either drawn from GP list or geographical locality), which enables continuity and the establishment of networks and relationships.Health visitors act as an interface between groups and individuals in the population, and population-based approaches.The health visiting contribution to public health takes account of the different dynamics and needs of individuals, families and groups, and the community as a whole, often working at a â€˜pre-needâ€™ stage.This proactive approach operates through the universal service, which is discussed further below.The universal service for infants and their families allows entry to whole communities and local areas.This includes outreach to family members from other age groups and vulnerable populations who may otherwise be excluded or who find services hard to access.Providing a service to everyone promotes acceptability, because no- one needs to feel stigmatised or particularly â€˜picked onâ€™ by an offer of health visiting services.Despite being universally available to all families with young children, the service is not delivered in a uniform way. Instead, it is personally tailored to each family and individual.Health visiting practice operates through relationships based on partnership and an empowerment (strengths-based) approach.The facilitators of this kind of working are well established, and include issues such as the practitioner having sufficient time to listen to clients, to develop a trusting relationship and having the knowledge and resources to respond to needs once they are identified; organisational resources such as clinical supervision are importantBarriers include the lack of communication skill, lack of time and knowledge, leading to an inability to adopt a suitably open and non- judgemental stance, and authoritarian management approaches, including pre-set requirements/criteria for assessment and service delivery. Cowley S. A funding model for health visiting: baseline requirements â€“ part 1. Community Practitioner 2007; 80(11): 18-24[ii] Cowley S. A funding model for health visiting (part 2): impact and implementation. Community Practitioner 2007; 80(12): 24-31[iii] Macleod J & G. Programs for the promotion of family wellness and the prevention of child maltreatment: a meta-analytic review. Child Abuse & Neglect, 2000. 24, 9, 1127â€“1149[iv] Council for the Education and Training of Health Visitors (CETHV) An Investigation into the Principles of Health Visiting CETHV London; 1977[v] Twinn S & Cowley S eds. The principles of health visiting: a re-examination Health Visitors' Association and UK Standing Conference on Health Visiting Education London 1992[vi] Cowley S & Frost M. The Principles of Health Visiting: Opening the door to public health. CPHVA & UKSC, London. 2006[vii] J Health visiting and health Political Issues in Nursing: Past, present and future Wiley & Sons Ltd (ed R White) 1985. 67-86 J, Effective healthcare and policy action: the example of health visiting (editorial) in Journal of Advanced Nursing, 32(6), 1315-1318, 2000[viii] Prime Research and Development. Developing standards and competences for Health Visiting. A report of the development process and thinking UKCC, London, 2001[ix] F, Cowley S & Buttigieg M (1995) Weights and Measures: Outcomes and evaluation in health visiting Health Visitors' Association London[x] World Health Organisation (WHO) Ottawa Charter for Health Promotion WHO Canada 1986[xi] World Health Organisation, Health Promotion Glossary WHO, Geneva, 1998[xii] Rijke R. Health in medical science: from determinism towards autonomy. In Lafaille R. & Fulder S eds Towards a New Science of Health Routledge, London 74-83 1993[xiii] Seedhouse D Health: The Foundations for Achievement Wiley and Sons, Chichester, 1986[xiv] Antonovsky A. Unraveling the Mystery of Health: How people manage stress and stay well Jossey Bass, San Francisco. 1987[xv] , H., Day, C., and Bidmead, C. Working in Partnership with Parents: The Parent Adviser Model. London, The Psychological Corporation. 2002[xvi]Bidmead C & Cowley S (in press) Partnership working to engage the client and health visitor The carrot or the stick? Towards effective practice with involuntary clients. (Editor: C Calder) (forthcoming 2008)sarahcowley183@...http://myprofile.cos.com/S124021COn

March 16, 2008

I absolutely agree Barbara.Â On 16 Mar 2008, at 16:21, Barbara -Todd wrote:Can I add school nursing to this debate too please? We are chronically understaffed and I am sure Cameron will appreciate this once his children begin school!Barbara health visiting practiceDear allIn view of the discussions, first about the possible increase in health visiting numbers, if the Tories are elected and do what they say they will, or if the present government pick up on it and increase staffing themselves, and second following the discussion sparked by 's revelations, I would be interested in views about how we should describe a 'proper' (ie, positive) health visiting service.ï¿½ï¿½As health visitors,ï¿½ I think we all recognise the potential harm from very fragmented service provision, but the challenge is to be able to describe this for commissioners and managers who are not health visitors.ï¿½ ï¿½I attach, and paste below for those who do not receive attachments, an excerpt from a paper Iï¿½ prepared at short notice for the Tory think tank (Centre for Social Justice) looking at early years provision.ï¿½ I would hasten to say that lots of others (including CPHVA) were contacted by them, so it was not only me briefing them about the need for more health visitors!ï¿½ï¿½However, we have a bit of space now to toss the ideas around and I wonder what I have missed out or if there are any points with which people disagree?ï¿½ Part of what was in my mind, was to refute the idea that any member of the children's service can deliver health visiting, and that the tasks/activities count more than the skills/abilities of the professionals concerned.ï¿½ I hope it might be helpful to and her CPTs, in arguing against the constraints being placed upon them.best wishesHealth visiting services:ï¿½ commissioning guidance includes[ii]ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting services should be developed according to an assessment of need at two different levels:oï¿½ï¿½ï¿½ï¿½ï¿½ The level of overall service provision is decided according to assessments at an area leveloï¿½ï¿½ï¿½ï¿½ï¿½ The level of service offered to a particular family is personalized according to individual assessmentsï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting services need to encompass prevention at three levels:ï¿½oï¿½ï¿½ï¿½ï¿½ï¿½ Universal prevention provided to all (incorporating the child health promotion programme)oï¿½ï¿½ï¿½ï¿½ï¿½ Indicated prevention (extra health visiting offered depending on individual assessments of need, e.g. for mental health concerns or children with special and complex needs, or for safeguarding)oï¿½ï¿½ï¿½ï¿½ï¿½ Selective prevention (e.g., to vulnerable groups like travelers, asylum seekers, looked after children; or intensive home visiting programmes to selected groups of parents)ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting services need to be based on best evidence and policy, byoï¿½ï¿½ï¿½ï¿½ï¿½ encompassing evidence based programmes (e.g., for selective provision, or for the child health promotion programme),oï¿½ï¿½ï¿½ï¿½ï¿½ providing individualized advice and support based on evidence based interventions, and according to assessed needï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ The evidence suggests that, in the early years, professionally led, multi-component services are most likely to be effective in supporting family wellness and prevention of child maltreatment[iii].ï¿½oï¿½ï¿½ï¿½ï¿½ï¿½ Health visiting is distinctive in providing a generic service that includes the key features listed above, which meets criteria for effectiveness.oï¿½ï¿½ï¿½ï¿½ï¿½ It should be well placed to achieve its potential in terms of enhanced support for infants, pre-school children and their families, although service reductions have an inhibiting effect.ï¿½oï¿½ï¿½ï¿½ï¿½ï¿½ Services that are both relationship-centred and strengths-based are experienced more positively by families than ones focused on risks and problems, or upon separate tasks to be delivered, which has implications for skillmix.ï¿½ï¿½The key features required for an effective health visiting service are now relatively well known and have been widely articulated within the health visiting literature and elsewhere[iv] [v] [vi] [vii] [viii] [ix][x] [xi] [xii] [xiii] [xiv] [xv] [xvi].ï¿½Health and well-being are viewed as positive concepts and a resource for everyday life; not merely the absence of disease or control of lifestyle choices and risks.ï¿½ï¿½Health visitors understand the bio-medical model of health and its importance in disease aetiology (pathogenesis), but they are primarily interested in what creates health (salutogenesis).ï¿½Concepts of health rooted in social, environmental and community concerns predominate.ï¿½The socio-cultural context is central to the aetiology of health inequalities, which are a major, current public health concern and a key area of interest for health visitors.Physical, mental and social well-being are all central to the meaning of ï¿½health.ï¿½ï¿½Health visiting practice often begins from a single, narrow point, then expands to a wider outlook.ï¿½ This operates at three levels:At an individual/family level, a surface reason for contact (e.g. discuss infant feeding) enables the opportunity for submerged and hidden needs to be identifiedCollaboration, co-ordination and networking shifts from a single individual or family to the wider community and back again, or from a single caseload across statutory and voluntary agencies.As health visitors work across these interfaces and with the biological, psychological, social and economic aspects of peopleï¿½s lives, they are able to gather and analyse information on different aspects of a communityï¿½s health and well-being.A long term outlook and understanding of the socio-cultural context, and how this can influence and the choices and activities adopted by individuals, families and communities, is required.ï¿½Health visitors hold a caseload of families located in a particular area (either drawn from GP list or geographical locality), which enables continuity and the establishment of networks and relationships.Health visitors act as an interface between groups and individuals in the population, and population-based approaches.ï¿½The health visiting contribution to public health takes account of the different dynamics and needs of individuals, families and groups, and the community as a whole, often working at a ï¿½pre-needï¿½ stage.ï¿½This proactive approach operates through the universal service, which is discussed further below.The universal service for infants and their families allows entry to whole communities and local areas.This includes outreach to family members from other age groups and vulnerable populations who may otherwise be excluded or who find services hard to access.Providing a service to everyone promotes acceptability, because no-one needs to feel stigmatised or particularly ï¿½picked onï¿½ by an offer of health visiting services.Despite being universally available to all families with young children, the service is not delivered in a uniform way.ï¿½ Instead, it is personally tailored to each family and individual.Health visiting practice operates through relationships based on partnership and an empowerment (strengths-based) approach.The facilitators of this kind of working are well established, and include issues such as the practitioner having sufficient time to listen to clients, to develop a trusting relationship and having the knowledge and resources to respond to needs once they are identified; organisational resources such as clinical supervision are importantBarriers include the lack of communication skill, lack of time and knowledge, leading to an inability to adopt a suitably open and non-judgemental stance, and authoritarian management approaches, including pre-set requirements/criteria for assessment and service delivery.ï¿½ï¿½ï¿½ Cowley S.ï¿½ A funding model for health visiting: baseline requirements ï¿½ part 1.ï¿½ Community Practitioner 2007; 80(11): 18-24[ii] Cowley S.ï¿½ A funding model for health visiting (part 2): impact and implementation.ï¿½ Community Practitioner 2007; 80(12): 24-31[iii] Macleod J & G. Programs for the promotion of family wellness and the prevention of child maltreatment: a meta-analytic review.ï¿½ Child Abuse & Neglect, 2000.ï¿½ 24, 9, 1127ï¿½1149[iv] Council for the Education and Training of Health Visitors (CETHV) An Investigation into the Principles of Health Visitingï¿½ï¿½ CETHV London; 1977[v] Twinn S & Cowley Sï¿½ eds.ï¿½ The principles of health visiting:ï¿½ a re-examination ï¿½ï¿½Health Visitors' Association and UK Standing Conference on Health Visiting Educationï¿½ Londonï¿½ 1992[vi] Cowley S & Frost M. ï¿½The Principles of Health Visiting:ï¿½ Opening the door to public health.ï¿½ CPHVA & UKSC, London.ï¿½ 2006[vii] Jï¿½ Health visiting and healthï¿½ Political Issues in Nursing:ï¿½Past, present and futureï¿½ Wiley & Sons Ltdï¿½ (ed R White)ï¿½ 1985.ï¿½ 67-86 J, Effective healthcare and policy action: the example of health visiting (editorial) in Journal of Advanced Nursing, 32(6), 1315-1318, 2000[viii] Prime Research and Development. Developing standards and competences for Health Visiting.ï¿½ A report of the development process and thinking UKCC, London, 2001[ix] F, Cowley S & Buttigieg M (1995)ï¿½ Weights and Measures:ï¿½Outcomes and evaluation in health visitingï¿½ Health Visitors' Associationï¿½London[x] World Health Organisation (WHO) Ottawa Charter for Health Promotionï¿½WHO Canada 1986[xi] World Health Organisation, Health Promotion Glossary WHO, Geneva, 1998[xii] Rijke R.ï¿½ Health in medical science: from determinism towards autonomy.ï¿½ Inï¿½ Lafaille R. & Fulder S edsï¿½ Towards a New Science of Healthï¿½Routledge, London 74-83ï¿½ 1993[xiii] Seedhouse Dï¿½ Health:ï¿½ The Foundations for Achievementï¿½ Wiley and Sons, Chichester, 1986[xiv] Antonovsky A.ï¿½ Unraveling the Mystery of Health:ï¿½ How people manage stress and stay wellï¿½ Jossey Bass, San Francisco.ï¿½ 1987[xv] , H., Day, C., and Bidmead, C. Working in Partnership with Parents: The Parent Adviser Model. London, The Psychological Corporation. 2002[xvi]Bidmead C & Cowley S (in press) Partnership working to engage the client and health visitor The carrot or the stick? Towards effective practice with involuntary clients.ï¿½ (Editor:ï¿½ C Calder) (forthcoming 2008)sarahcowley183btinternethttp://myprofile.cos.com/S124021COn'>http://myprofile.cos.com/S124021COnDear'>http://myprofile.cos.com/S124021COn'>http://myprofile.cos.com/S124021COnDear allIn view of the discussions, first about the possible increase inÂ health visiting numbers, if the Tories are elected and do what theyÂ say they will, or if the present government pick up on it andÂ increase staffing themselves, and second following the discussionÂ sparked by 's revelations, I would be interested in views aboutÂ how we should describe a 'proper' (ie, positive) health visitingÂ service.As health visitors,Â I think we all recognise the potential harm fromÂ very fragmented service provision, but the challenge is to be able toÂ describe this for commissioners and managers who are not healthÂ visitors.Â Â I attach, and paste below for those who do not receiveÂ attachments, an excerpt from a paper IÂ prepared at short notice forÂ the Tory think tank (Centre for Social Justice) looking at earlyÂ years provision.Â I would hasten to say that lots of othersÂ (including CPHVA) were contacted by them, so it was not only meÂ briefing them about the need for more health visitors!However, we have a bit of space now to toss the ideas around and IÂ wonder what I have missed out or if there are any points with whichÂ people disagree?Â Part of what was in my mind, was to refute the ideaÂ that any member of the children's service can deliver healthÂ visiting, and that the tasks/activities count more than the skills/ abilities of the professionals concerned.Â I hope it might be helpfulÂ to and her CPTs, in arguing against the constraints beingÂ placed upon them.best wishesï¿¼Health visiting services:Â commissioning guidance includes[ii]Â·Â Â Â Â Â Health visiting services should be developed according to anÂ assessment of need at two different levels:oÂ Â Â Â Â The level of overall service provision is decided according toÂ assessments at an area leveloÂ Â Â Â Â The level of service offered to a particular family isÂ personalized according to individual assessmentsÂ·Â Â Â Â Â Health visiting services need to encompass prevention at threeÂ levels:oÂ Â Â Â Â Universal prevention provided to all (incorporating the childÂ health promotion programme)oÂ Â Â Â Â Indicated prevention (extra health visiting offered dependingÂ on individual assessments of need, e.g. for mental health concerns orÂ children with special and complex needs, or for safeguarding)oÂ Â Â Â Â Selective prevention (e.g., to vulnerable groups likeÂ travelers, asylum seekers, looked after children; or intensive homeÂ visiting programmes to selected groups of parents)Â·Â Â Â Â Â Health visiting services need to be based on best evidence andÂ policy, byoÂ Â Â Â Â encompassing evidence based programmes (e.g., for selectiveÂ provision, or for the child health promotion programme),oÂ Â Â Â Â providing individualized advice and support based on evidenceÂ based interventions, and according to assessed needÂ·Â Â Â Â Â The evidence suggests that, in the early years, professionallyÂ led, multi-component services are most likely to be effective inÂ supporting family wellness and prevention of child maltreatment[iii].oÂ Â Â Â Â Health visiting is distinctive in providing a generic serviceÂ that includes the key features listed above, which meets criteria forÂ effectiveness.oÂ Â Â Â Â It should be well placed to achieve its potential in terms ofÂ enhanced support for infants, pre-school children and their families,Â although service reductions have an inhibiting effect.oÂ Â Â Â Â Services that are both relationship-centred and strengths- based are experienced more positively by families than ones focusedÂ on risks and problems, or upon separate tasks to be delivered, whichÂ has implications for skillmix.The key features required for an effective health visiting serviceÂ are now relatively well known and have been widely articulated withinÂ the health visiting literature and elsewhere[iv] [v] [vi] [vii]Â [viii] [ix][x] [xi] [xii] [xiii] [xiv] [xv] [xvi].Health and well-being are viewed as positive concepts and a resourceÂ for everyday life; not merely the absence of disease or control ofÂ lifestyle choices and risks.Health visitors understand the bio-medical model of health and itsÂ importance in disease aetiology (pathogenesis), but they areÂ primarily interested in what creates health (salutogenesis).Concepts of health rooted in social, environmental and communityÂ concerns predominate.The socio-cultural context is central to the aetiology of healthÂ inequalities, which are a major, current public health concern and aÂ key area of interest for health visitors.Physical, mental and social well-being are all central to the meaningÂ of â€˜health.â€™Health visiting practice often begins from a single, narrow point,Â then expands to a wider outlook.Â This operates at three levels:At an individual/family level, a surface reason for contact (e.g.Â discuss infant feeding) enables the opportunity for submerged andÂ hidden needs to be identifiedCollaboration, co-ordination and networking shifts from a singleÂ individual or family to the wider community and back again, or from aÂ single caseload across statutory and voluntary agencies.As health visitors work across these interfaces and with theÂ biological, psychological, social and economic aspects of peopleâ€™sÂ lives, they are able to gather and analyse information on differentÂ aspects of a communityâ€™s health and well-being.A long term outlook and understanding of the socio-cultural context,Â and how this can influence and the choices and activities adopted byÂ individuals, families and communities, is required.Health visitors hold a caseload of families located in a particularÂ area (either drawn from GP list or geographical locality), whichÂ enables continuity and the establishment of networks and relationships.Health visitors act as an interface between groups and individuals inÂ the population, and population-based approaches.The health visiting contribution to public health takes account ofÂ the different dynamics and needs of individuals, families and groups,Â and the community as a whole, often working at a â€˜pre-needâ€™ stage.This proactive approach operates through the universal service, whichÂ is discussed further below.The universal service for infants and their families allows entry toÂ whole communities and local areas.This includes outreach to family members from other age groups andÂ vulnerable populations who may otherwise be excluded or who findÂ services hard to access.Providing a service to everyone promotes acceptability, because no- one needs to feel stigmatised or particularly â€˜picked onâ€™ by anÂ offer of health visiting services.Despite being universally available to all families with youngÂ children, the service is not delivered in a uniform way.Â Instead, itÂ is personally tailored to each family and individual.Health visiting practice operates through relationships based onÂ partnership and an empowerment (strengths-based) approach.The facilitators of this kind of working are well established, andÂ include issues such as the practitioner having sufficient time toÂ listen to clients, to develop a trusting relationship and having theÂ knowledge and resources to respond to needs once they are identified;Â organisational resources such as clinical supervision are importantBarriers include the lack of communication skill, lack of time andÂ knowledge, leading to an inability to adopt a suitably open and non- judgemental stance, and authoritarian management approaches,Â including pre-set requirements/criteria for assessment and serviceÂ delivery. Cowley S.Â A funding model for health visiting: baselineÂ requirements â€“ part 1.Â Community Practitioner 2007; 80(11): 18-24[ii] Cowley S.Â A funding model for health visiting (part 2): impactÂ and implementation.Â Community Practitioner 2007; 80(12): 24-31[iii] Macleod J & G. Programs for the promotion of familyÂ wellness and the prevention of child maltreatment: a meta-analyticÂ review.Â Child Abuse & Neglect, 2000.Â 24, 9, 1127â€“1149[iv] Council for the Education and Training of Health VisitorsÂ (CETHV) An Investigation into the Principles of Health VisitingÂ Â Â CETHV London; 1977[v] Twinn S & Cowley SÂ eds.Â The principles of health visiting:Â aÂ re-examinationÂ Â Health Visitors' Association and UK StandingÂ Conference on Health Visiting EducationÂ LondonÂ 1992[vi] Cowley S & Frost M.Â The Principles of Health Visiting:Â OpeningÂ the door to public health.Â CPHVA & UKSC, London.Â 2006[vii] JÂ Health visiting and healthÂ Political Issues inÂ Nursing:Â Past, present and futureÂ Wiley & Sons LtdÂ (ed RÂ White)Â 1985.Â 67-86 J, Effective healthcare and policy action: the example ofÂ health visiting (editorial) in Journal of Advanced Nursing, 32(6),Â 1315-1318, 2000[viii] Prime Research and Development. Developing standards andÂ competences for Health Visiting.Â A report of the development processÂ and thinking UKCC, London, 2001[ix] F, Cowley S & Buttigieg M (1995)Â Weights andÂ Measures:Â Outcomes and evaluation in health visitingÂ HealthÂ Visitors' AssociationÂ London[x] World Health Organisation (WHO) Ottawa Charter for HealthÂ PromotionÂ WHO Canada 1986[xi] World Health Organisation, Health Promotion Glossary WHO,Â Geneva, 1998[xii] Rijke R.Â Health in medical science: from determinism towardsÂ autonomy.Â InÂ Lafaille R. & Fulder S edsÂ Towards a New Science ofÂ HealthÂ Routledge, London 74-83Â 1993[xiii] Seedhouse DÂ Health:Â The Foundations for AchievementÂ Â Wiley and Sons, Chichester, 1986[xiv] Antonovsky A.Â Unraveling the Mystery of Health:Â How peopleÂ manage stress and stay wellÂ Jossey Bass, San Francisco.Â 1987[xv] , H., Day, C., and Bidmead, C. Working in Partnership withÂ Parents: The Parent Adviser Model. London, The PsychologicalÂ Corporation. 2002[xvi]Bidmead C & Cowley S (in press) Partnership working to engageÂ the client and health visitor The carrot or the stick? TowardsÂ effective practice with involuntary clients.Â (Editor:Â CÂ Calder) (forthcoming 2008)sarahcowley183btinternethttp://myprofile.cos.com/S124021COn'>http://myprofile.cos.com/S124021COn sarahcowley183@...http://myprofile.cos.com/S124021COn

March 16, 2008

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I agree to - but we need to look at the school nurse issues in a different way - it seems the support is there but not the recognition of the shortages and the actual need to be clear what is needed to meet the policy agenda - this is not so for health visiting.

But I know the two do fit together

Margaret

health visiting practice

Dear all In view of the discussions, first about the possible increase in health visiting numbers, if the Tories are elected and do what they say they will, or if the present government pick up on it and increase staffing themselves, and second following the discussion sparked by 's revelations, I would be interested in views about how we should describe a 'proper' (ie, positive) health visiting service.ï¿½ï¿½